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Pries-Heje MM, Hjulmand JG, Lenz IT, Hasselbalch RB, Povlsen JA, Ihlemann N, Køber N, Tofterup ML, Østergaard L, Dalsgaard M, Faurholt-Jepsen D, Wienberg M, Christiansen U, Bruun NE, Fosbøl E, Moser C, Iversen KK, Bundgaard H. Clinical implementation of partial oral treatment in infective endocarditis: the Danish POETry study. Eur Heart J 2023; 44:5095-5106. [PMID: 37879115 DOI: 10.1093/eurheartj/ehad715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND AIMS In the Partial Oral Treatment of Endocarditis (POET) trial, stabilized patients with left-sided infective endocarditis (IE) were randomized to oral step-down antibiotic therapy (PO) or conventional continued intravenous antibiotic treatment (IV), showing non-inferiority after 6 months. In this study, the first guideline-driven clinical implementation of the oral step-down POET regimen was examined. METHODS Patients with IE, caused by Staphylococcus aureus, Enterococcus faecalis, Streptococcus spp. or coagulase-negative staphylococci diagnosed between May 2019 and December 2020 were possible candidates for initiation of oral step-down antibiotic therapy, at the discretion of the treating physician. The composite primary outcome in patients finalizing antibiotic treatment consisted of embolic events, unplanned cardiac surgery, relapse of bacteraemia and all-cause mortality within 6 months. RESULTS A total of 562 patients [median age 74 years (IQR, interquartile range, 65-80), 70% males] with IE were possible candidates; PO was given to 240 (43%) patients and IV to 322 (57%) patients. More patients in the IV group had IE caused by S. aureus, or had an intra-cardiac abscess, or a pacemaker and more were surgically treated. The primary outcome occurred in 30 (13%) patients in the PO group and in 59 (18%) patients in the IV group (P = .051); in the PO group, 20 (8%) patients died vs. 46 (14%) patients in the IV group (P = .024). PO-treated patients had a shorter median length of stay [PO 24 days (IQR 17-36) vs. IV 43 days (IQR 32-51), P < .001]. CONCLUSIONS After clinical implementation of the POET regimen almost half of the possible candidates with IE received oral step-down antibiotic therapy. Patients in the IV group had more serious risk factors for negative outcomes. At 6-month follow-up, there was a numerically but not statistically significant difference towards a lower incidence of the primary outcome, a lower incidence of all-cause mortality and a reduced length of stay in the PO group. Due to the observational design of the study, the lower mortality may to some extent reflect selection bias and unmeasured confounding. Clinical implementation of PO regimens seemed feasible and safe.
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Affiliation(s)
- Mia Marie Pries-Heje
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Julie Glud Hjulmand
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Try Lenz
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Nikolaj Ihlemann
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Lauge Østergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Dalsgaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Malene Wienberg
- Department of Cardiology, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jang W, Pai H, Kim B. Change in the Perception of Oral Antibiotics Among Medical Students After Participating in a Parenteral-to-Oral Conversion Program for Highly Bioavailable Antibiotics. Open Forum Infect Dis 2022; 9:ofac539. [PMID: 36349277 PMCID: PMC9636852 DOI: 10.1093/ofid/ofac539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 09/08/2024] Open
Abstract
Background Appropriate conversion of antibiotics from a parenteral to the oral route can lower the risk of catheter-associated infections, reduce medical costs, and shorten hospitalization. This study investigated the effect of a parenteral-to-oral conversion program for highly bioavailable antibiotics on the perceptions of medical students regarding oral antibiotics. Methods In 2021, the parenteral-to-oral conversion program was implemented as one of the activities of an antimicrobial stewardship program at a tertiary-care hospital in South Korea. This program was also implemented for fifth-year medical students in the hospital's infectious diseases department as a core clinical practice course. Medical students reviewed the medical records of patients taking antibiotics with a high oral bioavailability and wrote a recommendation for oral conversion after confirmation by an infectious disease specialist. A survey on the perception of oral antibiotics was administered to medical students before and after clinical practice to evaluate the educational effect of the program. Results A total of 923 cases were reviewed, and more than one-fifth of the antibiotics with a high oral bioavailability were administered parenterally despite their oral conversion (20.6%, 190/923). Of these, 24.2% (46/190) accepted the written proposal within 48 hours, and 43.7% (83/190) declined the proposal. Through this program, students gained a proper perception of oral antibiotics. Conclusions The parenteral-to-oral conversion program demonstrated an acceptance rate of oral antibiotic conversion in the hospital of 24.2% and had significant educational benefits for medical students, giving them the ability to construct an appropriate perception of oral antibiotics.
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Affiliation(s)
- Wooyoung Jang
- School of Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
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Marconi L, Tedeschi S, Zamparini E, Terzi S, Rossi N, Boriani L, Trapani F, Giannella M, Ruinato DA, Marchionni E, Gasbarrini A, Viale P. Oral versus standard antimicrobial treatment for pyogenic native vertebral osteomyelitis: a single center, retrospective, propensity score balanced analysis. Open Forum Infect Dis 2022; 9:ofac366. [PMID: 35959206 PMCID: PMC9361174 DOI: 10.1093/ofid/ofac366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Interest toward shorter antimicrobial regimens and oral treatment for osteoarticular infections is growing. The aim of this study is to assess whether there is an association between the administration of an entirely oral antibiotic therapy (OT) and the clinical outcome of native vertebral osteomyelitis (NVOs).
Methods
Single center, retrospective, observational study on consecutive patients with pyogenic NVOs over a 10-year period (2008-2018). Multivariate logistic regression analysis was carried out to identify risk factors for clinical failure, both in the whole population and in subgroups. The impact of OT versus standard treatment (intravenous induction followed by oral treatment whenever possible) was assessed in patients with a non-multidrug resistant microorganism (MDRO) etiology and the impact of a rifampin-containing regimen was assessed in patients affected by NVOs caused by staphylococci or of unknown etiology.
Results
Study population included 249 patients, 33 (13.3%) experienced clinical failure; OT group consisted of 54 patients (21.7%). Multivariate regression analysis of the whole population selected Charlson Comorbidity Index (aOR 1.291, 95% CI 1.114-1.497, p = 0.001) and MDRO etiology (aOR 3.301, 95% CI 1.368-7.964, p = 0.008) as independent factors for clinical failure. Among patients affected by a non-MDRO NVO, OT was not associated with an increased risk of clinical failure (aOR 0.487, 95% CI 0.133-1.782, p value = 0.271), even after adjustment for the propensity score of receiving OT. In the subgroup of patients with staphylococcal or unknown etiology NVO rifampin was independently associated with favorable outcome (aOR 0.315, 95% CI 0.105-0.949, p value = 0.040)
Conclusions
An entirely oral, highly bioavailable treatment, including rifampin, may be as effective as parenteral treatment in selected patients with NVOs.
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Affiliation(s)
- Lorenzo Marconi
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Correspondence: S. Tedeschi, MD, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy ()
| | - Eleonora Zamparini
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Silvia Terzi
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicolò Rossi
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Luca Boriani
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Filippo Trapani
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Elisa Marchionni
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Seaton RA, Ritchie ND, Robb F, Stewart L, White B, Vallance C. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother 2020; 74:2119-2121. [PMID: 30989175 DOI: 10.1093/jac/dkz122] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bone and joint infection contributes significantly to clinical activity within outpatient parenteral antimicrobial therapy (OPAT) services. The OVIVA (oral versus intravenous antibiotics for bone and joint infection) randomized study has challenged the practice of prolonged intravenous therapy, because non-inferiority of oral antibiotic therapy was demonstrated, thereby implying that early transition to oral therapy is an appropriate alternative to prolonged intravenous therapy. We examine the caveats to the study and discuss the implications for OPAT practice, highlighting the importance of careful oral antibiotic selection with attention to bioavailability, bone penetration, drug interactions, compliance and toxicity monitoring. We emphasize that ambulatory antibiotic therapy (whether intravenous or oral) in this patient group requires expert multidisciplinary management, monitoring and follow-up, and ideally should be undertaken within existing OPAT or, more accurately, complex outpatient antibiotic therapy (COpAT) services.
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Affiliation(s)
- R A Seaton
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - N D Ritchie
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - F Robb
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - L Stewart
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - B White
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - C Vallance
- Outpatient Parenteral Antimicrobial Therapy Service, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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5
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Kim JH, Fine DR, Li L, Kimmel SD, Ngo LH, Suzuki J, Price CN, Ronan MV, Herzig SJ. Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study. PLoS Med 2020; 17:e1003247. [PMID: 32764761 PMCID: PMC7413412 DOI: 10.1371/journal.pmed.1003247] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. METHODS AND FINDINGS We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59-0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33-0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57-2.17; p < 0.001) or patient-directed discharge (also referred to as "discharge against medical advice") (aOR 3.47; 95% CI 2.80-4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts. CONCLUSIONS Our findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.
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Affiliation(s)
- June-Ho Kim
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle R. Fine
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lily Li
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Simeon D. Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Joji Suzuki
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Christin N. Price
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Physicians Organization, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Matthew V. Ronan
- Department of Medicine, West Roxbury VA Medical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Shoshana J. Herzig
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Abstract
Intravenous antibiotics are overused in hospitals. Many infections can be managed with oral antibiotics Oral antibiotics avoid the adverse effects of intravenous administration. They are also usually less expensive When intravenous antibiotics are indicated, it may be possible to switch to oral therapy after a short course. There are guidelines to aid the clinician with the timing of the switch so that there is no loss of efficacy Infections that may be suitable for a short course of intravenous antibiotic include pneumonia, complicated urinary tract infections, certain intra-abdominal infections, Gram-negative bacteraemia, acute exacerbations of chronic lung disease, and skin and soft tissue infections Bone and joint infections and infective endocarditis are managed with prolonged courses of intravenous antibiotics. However, there is research looking at the feasibility of an earlier switch to oral antibiotics in these conditions
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Affiliation(s)
- Kate McCarthy
- Royal Brisbane and Women's Hospital, Brisbane.,Pathology Queensland, Brisbane.,Queensland Statewide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, University of Queensland, Brisbane
| | - Minyon Avent
- Royal Brisbane and Women's Hospital, Brisbane.,Pathology Queensland, Brisbane.,Queensland Statewide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, University of Queensland, Brisbane
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7
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Luo J, Long T, Cai Y, Teng Y, Fan Z, Liang Z, Zhu C, Ma H, Li G. Abscess Drainage with or Without Antibiotics in Lactational Breast Abscess: Study Protocol for a Randomized Controlled Trial. Infect Drug Resist 2020; 13:183-190. [PMID: 32021332 PMCID: PMC6983478 DOI: 10.2147/idr.s221037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background Lactational breast abscess, a complication from lactational mastitis, is a common cause of breastfeeding discontinuation. No consensus has been reached regarding the necessity of antibiotics in this disease. The purpose of this trial is to determine if surgical drainage is non-inferior to drainage together with a standard course of antibiotics, in the treatment of lactational breast abscess. Methods Breastfeeding females with breast abscess from 18 to 50 years old are eligible for study inclusion. An expected number of 306 patients will be randomly allocated in parallel to the intervention arm (simple drainage without antibiotics) or the control arm (abscess drainage with standard 5-day-course of antibiotics). The primary outcomes include the time to resolution of breast abscess and disease recurrence rate. Secondary outcomes of interests are 3-day-improvement proportion, rate of continuing breastfeeding, treatment failure rate, procedural-related complications, and length of hospital stay. An expected non-inferiority margin for the difference in the primary outcome of interest is set at 1 day, on the basis of a one-sided 97.5% confidence interval. Discussion This trial will provide first-hand evidence on whether simple abscess drainage is non-inferior to drainage together with a standard course of antibiotics, in lactational mothers with breast abscess. The indication of antibiotic prophylaxis could be revised if non-inferiority is set up, and guidelines for lactational breast abscess require amendments correspondingly. Trial Registration This study has been registered in the Chinese Clinical Trial Registry, and the trial registration number is ChiCTR1900024008.
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Affiliation(s)
- Jiayue Luo
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Tianzhu Long
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Yuanxuan Cai
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Yuan Teng
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Zhe Fan
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Zhen Liang
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Cairong Zhu
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Hongmin Ma
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Guanhua Li
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
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Clinical characteristics and outcomes of patients with septic arthritis treated without surgery. Eur J Clin Microbiol Infect Dis 2020; 39:897-901. [PMID: 31898794 DOI: 10.1007/s10096-019-03805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
Septic arthritis (SA) is typically managed with antibiotic therapy with or without surgery. Little is known about how patients without surgery differ from their operatively managed counterparts. We compared SA patients who received antibiotic treatment with and without surgery. We conducted a retrospective study of patients with monoarticular septic arthritis admitted to a single tertiary care centre between 1998 and 2015. All 441 monoarticular septic arthritis patients received antibiotics; 382 were also managed operatively and 59 nonoperatively. Nonoperative patients were older (64.4 vs 58.3 years old; p = 0.02) and less likely to have prior joint pathology (44.1% vs 67.5%; p < 0.001). Nonoperative patients presented more often with sepsis (37.3% vs 31.9; p = 0.02) and were more frequently admitted to the intensive care unit (23.7% vs 16.5%; p = 0.04). Nonoperative patients were less often discharged to a rehabilitation facility (37.9% vs 55.8%; p = 0.002) and less frequently readmitted to hospital within 60 days of initial discharge (15.3% vs 18.6%; p = 0.05). However, nonoperative patients were more likely to expire within 30 days after hospital discharge (11.9% vs 3.9%; p = 0.009). Nonoperative patients were sicker at presentation; despite deferral of surgery, they had a relatively high survival rate (88%). Among survivors whose data was available, there were no significant sequelae in post-discharge imaging. These findings support the nonsurgical approach as effective for patients with septic arthritis who are not critically ill at time of presentation.
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9
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Oral or intravenous antibiotics for complex orthopaedic infections? Drug Ther Bull 2019; 57:181. [PMID: 31570368 DOI: 10.1136/dtb.2019.000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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10
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Ma LL, Qiu Y, Song MN, Chen Y, Qu JX, Li BH, Zhao MJ, Liu XC. Clinical Trial Registration and Reporting: Drug Therapy and Prevention of Cardiac-Related Infections. Front Pharmacol 2019; 10:757. [PMID: 31333470 PMCID: PMC6624234 DOI: 10.3389/fphar.2019.00757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Clinical trials are the source of evidence. ClinicalTrials.gov is valuable for analyzing current conditions. Until now, the state of drug interventions for heart infections is unknown. The purpose of this study was to comprehensively assess the characteristics of trials on cardiac-related infections and the status of drug interventions. Methods: The website ClinicalTrials.gov was used to obtain all registered clinical trials on drug interventions for cardiac-related infections as of February 16, 2019. All registration studies were collected, regardless of their recruitment status, research results, and research type. Registration information, results, and weblink-publications of those trials were analyzed. Results: A total of 45 eligible trials were evaluated and 86.7% of them began from or after 2008 while 91.1% of them adopted interventional study design. Of all trials, 35.6% were completed and 15.6% terminated. Besides, 62.2% of interventional clinical trials recruited more than 100 subjects. Meanwhile, 86.7% of the eligible trials included adult subjects only. Of intervention trials, 65.8% were in the third or fourth phase; 78.1% adopted randomized parallel assignment, containing two groups; 53.6% were masking, and 61.0% described treatment. Moreover, 41.5% of the trials were conducted in North America while 29.3% in Europe. Sponsors for 40.0% of the studies were from the industry. Furthermore, 48.9% of the trials mentioned information on monitoring committees, 24.4% have been published online, and 13.3% have uploaded their results. Drugs for treatments mainly contained antibiotics, among which glycopeptides, β-lactams, and lipopeptides were the most commonly studied ones in experimental group, with the former ones more common. Additionally, 16.2% of the trials evaluated new antimicrobials. Conclusions: Most clinical trials on cardiac-related infections registered at ClinicalTrials.gov were interventional randomized controlled trials (RCTs) for treatment. Most drugs focused in trials were old antibiotics, and few trials reported valid results. It is necessary to strengthen supervision over improvements in results, and to combine antibacterial activity with drug delivery regimens to achieve optimal clinical outcomes.
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Affiliation(s)
- Lin-Lu Ma
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yang Qiu
- Cardiovascular Department, Kaifeng Central Hospital, Kaifeng, China
| | - Mei-Na Song
- Department of Nursing, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yun Chen
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jian-Xin Qu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bing-Hui Li
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Ming-Juan Zhao
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China.,Department of Cardiology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Xin-Can Liu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Lutwick L, Al-Maani AS, Mehtar S, Memish Z, Rosenthal VD, Dramowski A, Lui G, Osman T, Bulabula A, Bearman G. Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases. Int J Infect Dis 2019; 84:22-29. [PMID: 31005622 DOI: 10.1016/j.ijid.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.
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Affiliation(s)
- Larry Lutwick
- Mayo Clinic Health Care System, Eau Claire, WI, USA.
| | | | | | - Ziad Memish
- Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | | | - Grace Lui
- The Chinese University of Hong Kong, Hong Kong, China
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